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The following is a summary of “Outcomes of down-titration in patients with severe scalp alopecia areata initially treated with baricitinib 4-mg: Week 152 data from BRAVE-AA2,” published in the February 2025 issue of Journal of the American Academy of Dermatology by King et al.
Baricitinib, a selective inhibitor of the Janus kinase family of enzymes, is available in oral form and has received regulatory approval for the treatment of adults experiencing severe alopecia areata (AA).
Researchers conducted a retrospective study to present the week 152 efficacy findings from the phase 3 BRAVE-AA2 down-titration substudy.
They enrolled 546 adults with severe AA with a Severity of Alopecia Tool (SALT) score of 50 or higher in the BRAVE-AA2 trial. Participants receiving baricitinib 4 mg who achieved a clinical response (SALT score of 20 or lower) at week 52 were rerandomized in a 1:1 ratio to continue 4 mg or reduce the dose to 2 mg. Missing or censored data were imputed using the last observation carried forward method.
The results showed that at week 52, 86 of 234 (36.8%) individuals treated with baricitinib 4 mg were eligible for dose reduction, with 44 continuing 4 mg and 42 switching to 2 mg. By week 152, 39 of 44 (88.6%) individuals who remained on 4 mg maintained a clinical response, compared to 24 of 41 (58.5%) in the reduced-dose group. Among those who reduced to 2 mg, loss of treatment benefit occurred less frequently in individuals with a SALT score of 5 or lower at week 52.
Investigators concluded that over half of the patients whose treatment dosage was reduced maintained a positive response and that sustained treatment response and/or near-total hair regrowth might have predicted better maintenance of response after this down-titration.
Source: jaad.org/article/S0190-9622(24)03041-X/abstract
